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This process is initiated simultaneously by fat infiltration of hepatocytes, IR, and mitochondrial beta-oxidation, leading to increased ROS and eventual OS due to mitochondrial dysfunction, ER stress, derangement of iron metabolism, dysbiosis in the gut (including heightened ethanol-producing bacteria), and endothelial dysfunction (ED) [50,189]

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And there are also other potential confounding factors that have not been assessed in this study, for instance, patients with genetic predisposition, bariatric surgery-induced rapid weight loss, or hematological disorders, may predispose to gallstones